Medication Adherence in Patients Taking Immunosuppressants after Kidney Transplantation

Hee Jung Joo; Hoon Kim Young; Jong Han Duck; Suk Kim Kwang; Hui Chu Sang

doi:10.4285/jkstn.2010.24.4.289

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Joo, Young, Duck, Kwang, and Sang: Medication Adherence in Patients Taking Immunosuppressants after Kidney Transplantation

Original Article

J Korean Soc Transplant 2010;24(4):289-297.

Published online: 10 December 2010

DOI: https://doi.org/10.4285/jkstn.2010.24.4.289

Medication Adherence in Patients Taking Immunosuppressants after Kidney Transplantation

Hee Jung Joo, R.N.¹, Hoon Kim Young, M.D.², Jong Han Duck, M.D.², Suk Kim Kwang, Ph.D.³, Hui Chu Sang, Ph.D.³

¹Department of Nursing, Asan Medical Center, Seoul, Korea

²Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea

³Nursing Policy Research Institute, Yonsei University College of Nursing, Seoul, Korea

책임저자：추상희, 서울시 서대문구 신촌동 134연세대학교 간호대학 임상간호과학과, 120-752 Tel: 02-2228-3257, Fax: 02-392-5440 E-mail: shchu@yuhs.ac

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Kidney transplant recipients inevitably take a life-long immunosuppressive medication to prevent graft rejection. Non-compliance to immunosuppressive medication is one of the main causes leading to acute and chronic rejection and diminished renal function, resulting in a return to dialysis, increased morbidity, or mortality with an additional health care cost and poor quality of life. The purpose of this study was to investigate actual medication compliance and its related factors.

Methods

A total of 222 functioning kidney transplant recipients were surveyed in a single center, and 25 patients were excluded due to incomplete responses. We reviewed medical records retrospectively, and the data were statistically analyzed with SPSS version 13.0.

Results

Among 197 patients, 113 (57.4%) were compliant to the immunosuppressive agents, and 84 (42.6%) recipients were non-compliant. Non-compliant patients were significantly younger (P=0.004), highly educated (P=0.004), employed (P=0.005), more likely to live alone (P=0.035), and drank more (P=0.001) than the compliant patients. Regarding psychosocial factors, more barriers (P=0.015), weak beliefs about the necessity of taking medications (P=0.001), strong beliefs about specific concerns related to medications (P=0.038), and low self efficacy (P=0.003) were identified in the non-compliant group compared with the compliant group.

Conclusions

This study revealed that multiple factors affected medication compliance in patients taking immunosuppressants. It would be helpful to identify potential recipients with a risk for non-compliance based on their general characteristics and psychosocial factors, so they can be provided a specialized education program to promote compliance. This strategy may help produce more favorable long-term outcomes among kidney transplant recipients.

Keywords: Kidney transplant recipients, Immunosuppressants, Medication adherence

References

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Table 1.

Demographic characteristics of participants (n=197)

Variable	Category	N (%)	Mean (range)
Gender	Male	111 (56.4)
	Female	86 (43.6)
Age (years)	＜39	71 (36.0)	43.6±9.9
	40∼59	117 (59.4)	(18∼67)
	≥60	9 (4.6)
Body mass	＜18.5	15 (7.6)	22.3±3.1
index (kg/m²)	) 18.5∼22.9	101 (51.3)
	23∼24.9	46 (23.4)
	25∼29.9	31 (15.7)
	＞30	4 (2.0)
Education	None	1 (0.5)
	Elementary school	7 (3.6)
	Middle school	17 (8.6)
	High school	95 (48.2)
	More than College	77 (39.1)
Economic	High	8 (4.1)
status	Middle	123 (62.4)
	Low	66 (33.5)
Job	Yes	99 (50.3)
	No	98 (49.7)
Smoking	Yes	18 (9.1)
	No	179 (90.9)
Drinking	Yes	35 (17.8)
	No	162 (82.2)
Spouse	Yes	142 (72.1)
	No	55 (27.9)

Table 2.

Clinical characteristic of participants (n=197)

Variable	Category	N (%)	Mean (±SD)
Type of dialysis before transplantation	Hemodialysis	128 (64.9)
	Peritoneal dialysis	27 (13.7)
	Both	7 (3.6)
	None	35 (17.8)
Type of donor	Living (related donor)	90 (45.7)
	Living (non related donor)	49 (24.9)
	Deceased donor	58 (29.4)
Decision for transplantation	Own	83 (42.1)
	Medical Personnel’ s advice	25 (12.7)
	Family’ s	87 (44.2)
	Media	1 (0.5)
	Support group	1 (0.5)
Number of transplantation	1	189 (95.9)
	≥2	8 (4.1)
Experience of organ rejection	Yes	56 (28.4)
	No	141 (71.6)
Number of organ rejection	1	35 (17.8)
	2	14 (7.1)
	≥3	7 (3.5)
Duration with renal failure (years)	＜1	42 (21.3)	46.0±43.0
	1∼3	53 (26.9)	(1∼252)
	3∼5	36 (18.3)
	≥5	66 (33.5)
Duration after transplantation	＜1	62 (31.5)	46.7±49.4
	1∼3	54 (27.4)	(1∼206)
	3∼5	22 (11.1)
	5∼7	20 (10.2)
	≥7	39 (19.8)
Comorbid score	Tacrolimus	122 (61.9)	3.0±1.1
immunosuppressants	Cyclosporine	66 (33.5)
	Rapamycin	9 (4.6)
Number of medication	Adherent group	113 (57.4)	7.6±2.7
medication adherence	Non-adherent group	84 (42.6)

Table 3.

Rates of medication adherence (n=197)

Items	N (%)
Items	0%(none)	1∼20%	21∼50%	Greater than 50%(very frequent)
1. In the last 3 months, how often did you forget to take your immunosuppressant medication(s)?	137	57	3	0
	(69.5)	(28.9)	(1.5)	(0.0)
2. In the last 3 months, how often were you careless about taking your immunosuppressant medication(s)?	134	56	7	0
	(68.0)	(28.4)	(3.6)	(0.0)
3. In the last 3 months, how often did you stop taking your immunosuppressant medication(s) because you felt worse?	191	4	2	0
	(97.0)	(2.0)	(1.0)	(0.0)
4. In the last 3 months, how often did you miss taking your immunosuppressant medication(s) for any reason?	164	30	3	0
	(83.2)	(15.2)	(1.5)	(0.0)

Table 4.

Demographic characteristics and medication adherence (n=197)

Variable	Category	Adherent group (N=113)	Non-adherent group (N=84)	χ²	P
Gender	Male	58 (51.3)	53 (63.1)	2.713	0.100
	Female	55 (48.7)	31 (36.9)
Age (years)	＜39	31 (27.4)	40 (47.6)	8.517	0.004
	≥40	82 (72.6)	44 (52.4)
Body mass index (kg/m²)	＜18.5	8 (7.1)	7 (8.3)	0.576	0.750
	18.5∼22.9	56 (49.6)	45 (53.6)
	＞23	49 (44.3)	32 (38.1)
Education	Less than or middle school	18 (15.9)	7 (8.3)
	High school	62 (54.9)	33 (39.3)
	More than college	33 (29.2)	44 (52.4)	11.239	0.004
Economic status	High	6 (5.3)	2 (2.4)	1.315	0.518
	Middle	68 (60.2)	55 (65.5)
	Low	39 (34.5)	27 (32.1)
Job	Yes	47 (41.6)	52 (61.9)	7.952	0.005
	No	66 (58.4)	32 (38.1)
Smoking	Yes	8 (7.1)	10 (11.9)	1.351	0.245
	No	105 (92.9)	74 (88.1)
Drinking	Yes	11 (9.7)	24 (28.6)	11.702	0.001
	No	102 (90.3)	60 (71.4)
Spouse	Yes	88 (77.9)	54 (64.3)
	No	25 (22.1)	30 (35.7)	4.422	0.035

Table 5.

Clinical characteristics and medication adherence (n=197)

Variable	Category	Adherent group (N=113)	Non-adherent group (N=84)	χ²/t	P
Dialysis before transplantation	Yes	92 (81.4)	70 (83.3)	0.121	0.728
	No	21 (18.6)	14 (16.7)
Type of donor	Living	85 (75.2)	54 (64.3)	2.774	0.096
	Deceased	28 (24.8)	30 (35.7)
Decision for transplantation	Own	47 (41.6)	36 (42.9)	0.032	0.859
	Others	66 (58.4)	48 (57.1)
Number of transplantation	Once	107 (94.7)	82 (97.6)	1.061	0.303
	More than one	6 (5.3)	2 (2.4)
Experience of organ rejection	Yes	36 (31.9)	20 (23.8)	1.534	0.215
	No	77 (68.1)	64 (76.2)
Duration before transplantation	＜1	28 (24.8)	14 (16.7)	2.800	0.423
(years)	1∼3	27 (23.9)	26 (30.9)
	3∼5	22 (19.5)	14 (16.7)
	≥5	36 (31.8)	30 (35.7)
Duration after transplantation	＜1	37 (32.7)	25 (29.7)	2.732	0.604
(years)	1∼3	30 (26.6)	24 (28.7)
	3∼5	13 (11.5)	9 (10.7)
	5∼7	14 (12.4)	6 (7.1)
	≥7	19 (16.8)	20 (20.8)
Comorbid Score		3.0±1.1	2.9±1.0	0.972	0.834
Creatinine (mg/dl)		1.4±0.7	1.5±1.4	−1.035	0.302
Immunosuppressant	Tacrolimus	67 (59.3)	55 (65.5)	0.901	0.637
	Cyclosporine	40 (35.4)	26 (30.0)
	Rapamycin	6 (5.3)	3 (3.5)
Number of medicines		8.0±2.9	7.0±2.4	2.382	0.018
Symptom distress		53.9±17.7	54.2±13.9	−0.155	0.877

Table 6.

Psychosocial variables and medication adherence (n=197)

Variable	Total	Adherent group (N=113)	Non-adherent group (N=84)	t	P
Barriers	33.6±7.2	32.5±7.1	35.0±7.1	−2.446	0.015
Beliefs about medicines	34.1±6.1	34.4±5.9	33.8±6.4	0.641	0.522
– Necessity	21.0±4.1	21.9±3.5	19.9±4.5	3.469	0.001
– Concerns	13.1±4.8	12.5±5.1	13.9±4.3	−2.091	0.038
Self-efficacy	4.5±0.6	4.6±0.5	4.4±0.7	3.026	0.003
Depression	16.0±8.3	15.7±8.3	16.4±8.3	−0.525	0.600

Table 7.

Barriers to medication adherence (n=197)

Item	Total	Adherent group	Non-adherent group	t	P
1. I just forget to take my medicines some of the time.	1.8±0.9	1.2±0.8	2.1±0.9	−4.073	＜0.001
2. I run out of my medicine because I don’t get refills on time.	1.3±0.6	1.2±0.5	1.3±0.7	−1.301	0.195
3. My use of alcohol gets in the way of taking my medicines.	2.9±1.7	2.9±1.8	3.0±1.6	−0.537	0.592
4. I worry about how medicine will affect my sexual health.	2.2±1.2	2.1±1.2	2.3±1.2	−1.394	0.165
5. I sometimes forget things that are important to me.	2.6±1.2	2.5±1.2	2.7±1.1	−1.730	0.085
6. I have felt sad, down, or blue during the past months.	2.1±1.1	2.0±1.1	2.2±1.2	−1.287	0.200
7. I feel confident that each one of my medicines will help me.	2.0±1.2	1.9±1.1	2.1±1.2	−1.544	0.124
8. I know if I am reaching my health goals.	2.6±1.2	2.6±1.2	2.7±1.1	−0.548	0.585
9. I have someone who I can call with questions about my medicines.	2.5±1.3	2.5±1.3	2.6±1.2	−0.669	0.504
10. I understand my doctor’ s/nurse’ s instructions about the medicines I take.	2.0±1.0	1.9±1.1	2.1±1.0	−1.546	0.124
11. My doctor/nurse and I work together to make decisions.	2.2±1.1	2.0±1.2	2.3±1.1	−1.311	0.191
12. I am able to read and understand pill bottle labels.	2.4±1.2	2.4±1.2	2.4±1.1	−0.358	0.721
13. Taking medicines more than once a day is inconvenient.	2.5±1.2	2.4±1.2	2.6±1.2	−1.288	0.199
14. I have to take too many medicines a day.	3.1±1.2	3.1±1.2	3.0±1.3	0.412	0.681
15. It is hard for me to swallow the pills I have to take.	1.5±0.9	1.6±1.0	1.5±0.8	0.694	0.489

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